Provider Demographics
NPI:1861668816
Name:KAGALWALLA, TASNEEM A
Entity Type:Individual
Prefix:
First Name:TASNEEM
Middle Name:A
Last Name:KAGALWALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8804
Mailing Address - Country:US
Mailing Address - Phone:630-922-8501
Mailing Address - Fax:
Practice Address - Street 1:1112 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8804
Practice Address - Country:US
Practice Address - Phone:630-922-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist